Provider Demographics
NPI:1982936464
Name:ARK, SUZANNE RENEE' (CACDI, LPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RENEE'
Last Name:ARK
Suffix:
Gender:F
Credentials:CACDI, LPC INTERN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENEE'
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 LANCASTER DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-584-1906
Mailing Address - Fax:503-584-1952
Practice Address - Street 1:460 LANCASTER DRIVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-584-1906
Practice Address - Fax:503-584-1952
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02-03-09101Y00000X, 101YA0400X
OR12-06-07101YA0400X
ORR5063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)